When you think about a pelvic floor physiotherapist, the first thing most people think of is that WH physios teach pelvic floor exercises and quite often, even amongst a few doctors, that’s ALL we teach patients. But as you have read from many of my blogs, the treatment strategies involved for stress urinary incontinence, the overactive bladder, vaginal or rectal prolapse, bowel dysfunction, persistent pelvic pain and other conditions involve quite a number of different treatment strategies – and each of them – and the sum of all of them – are what contribute to a solution for each of these problems.
That’s what is going wrong for women when they lament that they are doing their pelvic floor exercises but they are still leaking/ soiling/suffering frequency and urgency/feeling a vaginal bulge/ getting pelvic pain/having sexual dysfunction and so on. If the only piece of advice they have been given is to “Do your pelvic floor exercises” then it is highly unlikely that they will improve. For some, doing pelvic floor exercises may make them worse – especially if they have pelvic pain caused or exacerbated by overly tight pelvic floor muscles. They may in fact do much better to learn how to relax their pelvic floor muscles.
If we look at a real life problem such as bowel dysfunction – constipation and/or obstructed defaecation. Below are the pieces of the treatment pie:

• The first important part of the treatment is accurate assessment of the bowel issues deciding how much is related to true slow transit constipation; how much is obstructed defaecation where pelvic floor descent or a prolapse may be the problem and what component is due to an incoordination of the tummy and pelvic floor muscles.
• Assess the effect of the bowel problem on the bladder and the rest of the body (eg breathing, vaginal wall laxity)
• Education regarding dietary advice;
• Product advice;
• Defaecation position advice;
• Learning the dynamics of defaecation to achieve nice coordination between the abdominal muscles and the external anal sphincter;
• Pelvic floor muscle training;
• Bracing with increased intra-abdominal pressure such as with bending, coughing, sneeze to minimize further descent of the pelvic floor;
• Appropriate knowledge of normal bladder function (as there are often concurrent bladder problems).

So here’s a diagrammatic representation – let’s put it into practice! (Sorry for the miniscule picture) and remember there is a similar ‘pie’ for each of the problems to do with pelvic floor dysfunction.

And the next blog is going to be on the hardest part about all this – Compliance : It’s got to be for life!
See Find a Physio on the APA website to help you source a Continence and Women’s Health Physio near you or ring the Continence Foundation of Australia 1800 33 00 66.